Received December 14, 1999
Accepted January 15, 2000

To determine the accuracy of hysterosalpingography with relation to hysteroscopy for detection of intrauterine abnormalities in infertile patients. Design: Cross-sectional study. Setting: University hospital. Subjects: 375 women of an assisted fertilization program. Intervention: Patients were submitted to hysteroscopy and hysterosalpingography prior to intra uterine insemination or in vitro fertilization. Main outcome measures: Hysterosalpingograpic and hysteroscopic findings. Results: Hysteroscopy proved satisfactory in 95.2% of cases. Two-hundred and twenty-two patients (62.2%) had a normal hysteroscopic evaluation. The most prevalent hysteroscopic findings were: cervical stenosis (n=46); chronic endometritis (n=23); synechiae (n=23); endometrial hyperplasia (n=19); polyps (n=17); and myomas (n=10). The comparison of histeroscopic and histerosalpingographic findings revealed a sensitivity of 52.3% and a specificity of 85.1% for hysterosalpingography; the positive and negative predictive values were 65.7% and 76.5%, respectively. Conclusions: Hysterosalpingography is not sufficiently accurate or sensitive for screening pathologies of the endometrial cavity in infertile patients. Hysteroscopy should be performed in all patients before IVF and artificial insemination.